SCURVY can present with hemarthrosis and musculoskeletal symptoms that closely mimic inflammatory rheumatologic disease.
Scurvy and Musculoskeletal Symptoms
A rare case of scurvy in a 53-year-old man highlights how vitamin C deficiency can present with musculoskeletal symptoms, rash, joint swelling, and hemarthrosis, creating diagnostic overlap with inflammatory arthritis, inflammatory myopathy, vasculitis, or neurologic disease.
The patient was admitted with progressive proximal muscle weakness and near-syncope. He also reported pain and swelling of the left knee and ankle, lower extremity rash, and painful teeth and gums. Physical examination showed large spontaneous ecchymoses and petechiae over the lower extremities, left knee and ankle effusions, mild gingival bleeding, and proximal lower extremity weakness.
Initial laboratory evaluation showed elevated C-reactive protein at 56 mg/L, anemia with hemoglobin of 9.6 g/dL, and folate deficiency. However, white blood cell count, platelet count, creatinine, liver transaminases, creatine kinase, vitamin B12, erythrocyte sedimentation rate, prothrombin time, and partial thromboplastin time were within normal limits.
Hemarthrosis Shifted the Diagnosis
The combination of elevated inflammatory markers, petechiae, joint swelling, and weakness initially prompted concern for systemic autoimmune disease. Serologic testing, including antinuclear antibody, anti-SSA antibody, antineutrophil cytoplasmic antibody, anti-tissue transglutaminase IgA antibody, rheumatoid factor, and myositis-specific antibodies, was negative.
Diagnostic arthrocentesis of the left knee yielded 15 mL of frankly bloody synovial fluid, shifting the differential away from inflammatory rheumatologic disease and toward a bleeding diathesis. Subsequent testing revealed an undetectable serum vitamin C level. The patient was started on oral ascorbic acid 1,000 mg daily, with progressive clinical improvement, and was discharged to short-term rehabilitation.
Food Insecurity as a Clinical Clue
The case was notable because the patient did not have behavioral or psychiatric conditions commonly associated with severe nutritional deficiencies. Instead, the primary risk factor was food insecurity, with a diet consisting predominantly of fast food and pizza.
The authors emphasized that scurvy should remain in the differential diagnosis for unexplained petechiae, ecchymoses, gingival bleeding, musculoskeletal pain, weakness, joint effusions, or hemarthrosis, particularly when dietary restriction or food insecurity is present. Focused, nonjudgmental dietary history may be critical when inflammatory markers and musculoskeletal symptoms obscure an underlying nutritional deficiency.
Reference
Greenblatt HK et al. Food For Thought: An Unusual Case of Scurvy with Hemarthrosis and Musculoskeletal Symptoms. Brown Hospital Medicine. 2026;DOI: 10.56305/001c.164080.
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